The impact of gender and NASH on chronic kidney disease before and after liver transplantation

Authors

  • Lynn A. Fussner,

    1. Department of Internal Medicine, Mayo Clinic Transplant Center, Rochester, MN, USA
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  • Michael R. Charlton,

    1. Department of Internal Medicine, Mayo Clinic Transplant Center, Rochester, MN, USA
    2. Division of Gastroenterology and Hepatology, Mayo Clinic Transplant Center, Rochester, MN, USA
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  • Julie K. Heimbach,

    1. Department of Surgery, Mayo Clinic Transplant Center, Rochester, MN, USA
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  • Chun Fan,

    1. Division of Biomedical Statistics and Informatics, Mayo Clinic Transplant Center, Rochester, MN, USA
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  • Ross Dierkhising,

    1. Division of Biomedical Statistics and Informatics, Mayo Clinic Transplant Center, Rochester, MN, USA
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  • Elizabeth Coss,

    1. Department of Internal Medicine, Mayo Clinic Transplant Center, Rochester, MN, USA
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  • Kymberly D. Watt

    Corresponding author
    1. Department of Internal Medicine, Mayo Clinic Transplant Center, Rochester, MN, USA
    2. Division of Gastroenterology and Hepatology, Mayo Clinic Transplant Center, Rochester, MN, USA
    • Correspondence

      Kymberly D Watt, MD, Division of Gastroenterology and Hepatology, Mayo Clinic and Foundation CH-10 200 First St. S.W. Rochester, MN 55905, USA

      Tel: +507 266 1586

      Fax:+507 266 1856

      e-mail: watt.kymberly@mayo.edu

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Abstract

Background & Aims

Chronic kidney disease (CKD) after liver transplant (LT) is associated with increased long-term mortality. The impact of gender on CKD before and after LT is unknown. To further define risk factors and analyse gender differences in the incidence and progression of CKD after liver transplant.

Methods

Four hundred and fifty-five consecutive adult primary solitary LT recipients were included. Iothalamate clearance tests performed over time were analysed.

Results

Mean age was 51.4 ± 10.4 years with 63% males. A percentage of 29.1% of females and 21.1% of males had a GFR<60 ml/min/1.73 m2 and 10.2% of females and 5.9% of males had GFR<30 ml/min/1.73 m2 prior to transplant. At 1 year, 52.6% of recipients tested (69.6% females, 43.0% males) had GFR<60 ml/min/1.73 m2 and 7.3% (11.6% females, 4.9% males) had GFR<30 ml/min/1.73 m2. Pre-LT GFR<60 ml/min/1.73 m2 [OR 3.28, (1.76–6.10), P ≤ 0.001], female gender (OR 2.96, (1.72–5.10), P < 0.001) and age [OR 1.09, (1.05–1.12), P < 0.001] were independently predictive of stage ≥3 CKD at 1 year post-LT. Female gender [OR 2.52, (1.25–4.71), P = 0.004], age [OR 1.05, (1.02–1.08), P = 0.003] and NASH [OR 2.95, (1.06–8.21), P = 0.039] were independently predictive of ≥stage 3 CKD at 5 years post-LT. Pre-LT diabetes was associated with stage 4 CKD at 5 years [OR 2.91, (1.33–6.36), P = 0.008] post-LT.

Conclusions

In addition to age and pre-LT CKD, female gender and NASH are independent predictors of ≥stage 3 CKD post-LT. Gender-based approaches to optimize modifiable risk factors are needed to improved post-transplant renal function.

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